Composite Restorations

At the end of the lecture:

Discuss the composition of the composites

Discuss the different classifications of
composites
Discuss the properties of composites
Discuss the mechanism of adhesion of
composites to enamel and dentin
Discuss the step by step procedure in composite
filling
Types of Esthetic Restorative Materials
Silicate cements
Acrylic resin
Composite
conventional
microfill
hybrid
flowable
packable composites
nanofill
GIC
resin modified GIC
compomers (polyacid modified composites)
Silicate cement
First translucent filling material
Introduced in 1878 by Fletcher in England
Composed of:
- acid soluble silicate glass (powder), phosphoric acid (liquid), water,
buffering agents
Due to its high fluoride content and solubility, the adjacent enamel
becomes more resistant to recurrent caries
cavity prep. is conventional (boxlike) and a butt joint was required
because material is brittle and has a poor edge strength
Could last for approx. 4yrs. (10yrs. have been reported)
Disadvantage:
- discoloration and loss of contour
- highly soluble in oral fluids marginal leakage
Acrylic Resin
Self-curing (chemically activated) acrylic resin for
anterior restorations; developed in Germany in 1930s
but marketed in late 40s

Disadvantages:
- high polymerization shrinkage, high CTE, lack of
abrasion resistance marginal leakage pulp injury,
recurrent caries, discoloration and excessive tooth wear

Preparation either conventional or beveled conventional

 Unfilled Acrylic Systems
No fillers
Based on polymethyl methacrylate
Disadvantages:
- poor strength
- wears easily
- excessive polymerization contraction marginal
leakage
 How to solve poor properties?
ceramic fillers added
Polymethyl methacrylate replaced with
- BIS-GMA (bisphenol glycidyl methacrylate)
- UDM (urethane dimethacrylate)
*organic matrix of composites
Diluents
- TEGDMA (low viscosity monomer)
- counteracts viscosity of BIS GMA and UDM
 Conventional composites
Contains approx. 75-80% inorganic filler by weight

In 1980s average particle size is 8mm; exhibit a rough

surface texture

Resin matrix wears at a faster rate than fillers (i.e.,strontium,

barium, quartz making it radiopaque in x-ray), further roughening
the surface susceptible to discoloration and extrinsic
staining

Have a higher amount of initial wear at occlusal contact

areas than do microfill or hybrid types
Microfill composites
Introduced in late 70s; they are designed to replace the rough
surface characteristic of conventional composites
Contains colloidal silica particles (0.01-0.04mm) which results in a
smooth, polished surface in the finished restoration
Microfill composites have an inorganic filler content of approx. 35-
60% by weight

Because they contain less filler than conventional or hybrid co,

some of their mechanical
and physical characteristics are
inferior
Clinically they are very wear
resistant
Hybrid composites
Combination of physical & mechanical properties of
conventional and smooth surface microfill composites
Have an inorganic filler content of approx. 75-85% by
weight

Mixture of microfiller and small filler particles(0.4-1mm)

Due to relatively high content of inorganic fillers, the
physical and mechanical characteristics are generally
superior
They are the predominant direct
esthetic restorative materials used
Flowable composites
Have a lower filler content & inferior physical properties
(low wear resistance and strength)

They exhibit much higher polymerization shrinkage and

should always be placed in thin layers

Appropriate for use in Class I,

as pit & fissure sealants, as
marginal repair materials, or
first increment placed as a liner
Nanofill composites (nanofill hybrids)

Contains filler particles that are extremely small (0.005-

0.01m)
Higher filler levels can be generated in the restorative
material, resulting in good physical properties and
esthetics

Small particle size makes

nanofills highly polishable
Because of these qualities, they
are likely to become a popular
restorative filling material of
choice
Compositions
Continuous phase
Dispersed phase
Coupling agents
Pigments
Modifiers
Composition
Continuous phase
matrix phase
organic portion
less desirable properties
BIS GMA or UDM with TEGDMA
Purpose: gives initial mixture its flowability
and moldability
Composition
Dispersed phase
filler phases
desirable properties
Purpose: provides 1. strength 2. light
scattering & transmission
composed of:
- fillers (inorganic phase) silica fillers (non-
crystalline & crystalline)
- other ions aluminum, lithium, boron,
barium, zinc, zirconium, yttrium (radiopaque)
Composition
Coupling agent bond between the organic
resin matrix & the inorganic filler
intermediate phase between the filler & matrix
Purpose: strengthens the bond between
continuous phase and dispersed phase.
Why is it important?
- increases the strength of the composite
- reduces solubility & water absorption
Composition
Pigments
purpose: gives composites different shades
i.e. inorganic oxides
Modifiers
A. hydroquinone
- inhibitor
- increases shelf life
B. coloring agents inorganic oxides
C. UV light absorbers
- prevents discoloration of the oxide during sunlight
exposure
Classifications of Composites

1. According to methods of polymerization or

curing

2. According to particle size

Methods of polymerization:
Two Ways:
A. Chemical curing (self cure)
- 2 paste system: catalyst (tertiary amine activator) &
base (benzoyl peroxide initiator)
B. Light curing
- 1 paste system
- makes use of a light sensitive absorber or a
photoinitiator such as:
camphorquinone for visible light cured
composite
benzoin methyl ether for UV light cured
composite
Polymerization
1. Free radical polymerization
2. Stages:
a.) initiation start of reaction
b.) propagation chain reaction progresses
c.) termination end
3. Inhibited by a material that will react with the free
radicals
What may happen?
1) rate of polymerization will decrease
2) rate of termination will increase
i.e. eugenol, hydroquinone, thus no ZOE
Methods of Curing
1. Self-cured/ chemically cured
- Greater chance for air inclusion in the mixture and greater internal
porosity, less color stability
2. Light cured
- May cause retinal damage, unless appropriate precaution are
taken
- Exhibit greater color stability & less internal porosity
- Effects of polymerization shrinkage can be partially compensated
by incremental insertion and curing technique
- Significantly increase heat generation and polymerization
shrinkage stresses
Polymerization shrinkage composite materials shrink while
hardening
3. Visible light cured
Before: UV light but curing was limited & posses safety
hazards
Visible light cures through enamel, 2mm thick
Particle size
A. Megafillers large filler inserts
B. Macrofillers 10 to 100 *
C. Midfillers 1 to 10
D. Minifilllers - .1 to 10
E. Microfillers - .01 to .1 *
F. Nanofillers ultra small fillers, .005 - .01
G. Hybrid fillers bomidal or trimodal blend*, classified by
larger particle size

* homogenous or heterogenous
Particle size
Macrofillers
large particle small surface area more fillers less matrix

Microfillers
small particle bigger surface area more matrix less fillers
 Comparison of Composite Filling
Material
Macrofillers Microfillers Hybrid fillers
Average particle 8 to 10 .02 to .04 .1 to 1
size

Filler % 75 to 80 % 35 to 60 % 75 to 85 %
(by weight)

Matrix % 15 to 25 % 15 to 40 % 15 to 25 %
Physical Stronger, Less strength, Better physical
properties harder, better less wear properties
wear resistance resistance

Polishability Very poor Very good Polishable

Indication - Anterior Posterior
restorations restorations
Most Commonly Used Composite
Microfilled and Hybrid composite
Desirable properties:

1. Microfills
- more esthetic, better depth & color, and more lifelike
reflective properties, polish to high gloss. Ideal for
anterior restorations

2. Hybrids
- greater strength and more opaque. For both anterior
and posterior restorations.
Physical Properties
Polymerization shrinkage
Thermal properties
Water sorption
Solubility
Mechanical properties
Radiopacity
Depth cure
Properties
Polymerization shrinkage
- one of the major setbacks of composite
- shrinks upon curing (light cured towards light
source)
- offset by acid etching
- results of polymerization shrinkage?
marginal leakage
tooth sensitivity
pulpal sensitivity
post-operative sensitivity
Properties

Thermal properties

Coefficient of Thermal Expansion

- materials contract or expand depending on
temperature changes in the mouth
- more fillers in composite lower CTE
Properties

Thermal conductivity
- minimal in composites
- greater in organic phase than in the
matrix
Properties
Water absorption
- when a resto. material absorbs water, its properties
change, and its effectiveness as a resto. material is
diminished
- all tooth-colored materials exhibit some water
absorption
- materials with higher filler content exhibit lower water
absorption

*greater in microfill because there is more matrix

Properties

Solubility
- composite do not show any clinically relevant
solubility
- composite can be soluble to alcohol
- inadequate polymerization greater solubility
and sorption
Properties

Mechanical properties
- composite have lower mechanical properties
than amalgam
- greater strength for macrofill than microfill
compressive strength
tensile strength
abrasive wear resistance
To increase wear resistance of
composite:

Make sure it is properly polymerized

Use strontium in glass ( stronger than silica)
Minimize air inclusion upon manufacture
Condense well when using visible light cured
composite
Hybridization
Depth of cure

Dependent on:
Distance of light source
-
Degree of intensity light absorbed
Shade
- darker shade, longer polymerization
Exposure time
- longer exposure time, better curing
 Smear layer layer of dentinal shavings that will get
compacted into the surface of cut dentin after rotary
instrumentation

Smear plug the part of the smear layer that goes into
the dentinal tubules
Adhesion to Enamel

Bonding depends on resin tags becoming interlocked

with the surface irregularities created by etching
( macrotags & microtags)

Better bonding would offset polymerization shrinkage

and CTE:

decreases marginal leakage

increases marginal adaptation
Adhesion to Dentin
Conditioner
dissolves intertubular dentin

Primer
with hydrophilic & hydrophobic components
Hydrophilic ends bind to dentin
Hydrophobic end binds to bonding agent

Bonding agent
helps stabilize the hybrid layer
Cavity preparation
General Considerations:

1. Outline form determined by extent of caries

2. No need for extension for prevention
3. Contact areas placed on natural tooth
4. Leave undermined enamel for retention and
esthetics
5. Create rounded junctions
Preparation of enamel walls

Bevel
1. partial bevel
2. long bevel
3. rounded bevel
Acid Etching

20 30 sec.
Acids are used to dissolve the inorganic
component of the dentin which creates
irregularities/porosities on the surface of the
tooth to create mechanical interlocking called
RESIN TAGS
Most common agent: Phosphoric acid 20-40%

* Deciduous teeth are longer to etch because of irregularly arranged

enamel rods
Acid Etching
Principles:
1. Cavity preparation should mechanically cleansed (using
pumice)
2. Etch 1mm beyond the margins
3. Rinse etched surface for a period about equal to the
etch time
4. Do not overdry dentin surface leave it moist
5. After etching dentin should appear glossy and enamel
should appear dull and chalky
6. In case of moisture contamination RE-ETCH
Step by step procedure in Composite filling

1. Clean tooth with slurry

of pumice ( rubber
cup at low speed)
2. Shade selection
3. Isolate operative field
Step by step procedure in Composite filling

4. Acid etching with 37-50% phosphoric

acid for 15 to 30 secs.
5. Wash off etchant with water 20-30 secs.
(for gel), 10-15 secs. (for liquid)
Step by step procedure in Composite filling

6. Dry with clean, moisture and oil free air for 20

secs.
7. Application of celluloid strip and wedge
8. Apply bonding agent on etched tooth surface
and thin out with blast of air
9. Cure bonding agent for 20 secs.
10. Place composite in 2mm thickness increments
and cure for 40 secs.
Step by step procedure in Composite filling

11. Repeat until entire cavity filled

12. Post cure for 40-60 secs.
13. Remove celluloid strip and
wedge
14. Trim excess composite with
composite trimmer, carbide
or diamond finishing bur
15. Polish with flexible discs,
polishing strips, and
aluminum oxide polishing
pastes
Contraindications of Composite

1. Isolation
2. Occlusion
3. Operator factors
Advantages of Composite
1. Esthetic
2. Conservative tooth structure removal
3. Less complex preparing the tooth
4. Insulative, having low thermal conductivity
5. Used almost universally
6. Bonded to tooth structure, resulting in good retention,
low microleakage, minimal interfacial staining, and
increased strength of remaining tooth structure
7. Repairable
 Disadvantages of Composite
1. May have a gap formation, usually occurring on root surfaces as a
result of polymerization shrinkage
2. Are more difficult, time-consuming and costly
3. Are more technique sensitive
- Tooth treatment for bonding requires multiple step
- Insertion is more difficult
- Establishing proximal & occlusal contacts, axial contours, and
embrasures maybe more difficult
- Finishing and polishing procedures are more difficult
4. May exhibit greater occlusal wear in areas of high occlusal stress
(esp. when tooth contacts are more on the composite material)
5. Have a higher CTE, resulting in potential marginal percolation if an
inadequate bonding technique is used.
Conventional GIC
Developed in 1972 by Wilson and Kent
Powder/liquid system, the same characteristics of silicate
cement
They release fluoride into tooth structure yielding a
potential anti-cariogenic effect, and possess a favorable
CTE
Polyacrylic acid (liquid) renders the resto. material less
soluble
Technique sensitive regarding mixing and insertion
procedures
Because of its low resistance to wear, it is not
recommended for occlusal areas
Read: Part 3:Composite Restorations (Chapters 11-15)
Sturdevants Art and Science of Operative Dentistry 5 th edition

Thank you